Cholera outbreak caused by drug resistant Vibrio cholerae serogroup O1 biotype ElTor serotype Ogawa in Nepal; a cross-sectional study.

Pappu Kumar Gupta,Ramkrishna Bhandari,Narayan Dutt Pant,Padma Shrestha

doi:10.1186/s13756-016-0122-7

Abstract

BackgroundCholera is a major cause of mortality and morbidity in underdeveloped countries including Nepal. Recently drug resistance in Vibrio cholerae has become a serious problem mainly in developing countries. The main objectives of our study were to investigate the occurrence of Vibrio cholerae in stool samples from patients with watery diarrhea and to determine the antimicrobial susceptibility patterns of V. cholerae isolates.MethodsA total of 116 stool samples from patients suffering from watery diarrhea during July to December 2012 were obtained from outbreak areas from all over Nepal. Alkaline peptone water and thiosulphate citrate bile salt sucrose agar (TCBS) were used to isolate the Vibrio cholerae. The isolates were identified with the help of colony morphology, Gram’s staining, conventional biochemical testing, serotyping and biotyping. Antimicrobial susceptibility testing was performed by determining the minimum inhibitory concentration (MIC) by agar dilution method.ResultsVibrio cholerae was isolated from 26.72 % of total samples. All isolated Vibrio cholerae were confirmed to be Vibrio cholerae serogoup O1 biotype El Tor and serotype Ogawa. All isolates were resistant to ampicillin and cotrimoxazole. Twenty nine isolates were resistant toward two different classes of antibiotics, one strain was resistant to three different classes of antibiotics and one strain was resistant to four different classes of antibiotics. According to the definition of the multidrug resistant bacteria; 6.45 % of the strains of Vibrio cholerae were found to be multidrug resistant.ConclusionsCholera due to multidrug resistant Vibrio cholerae is also possible in Nepal. According to the antimicrobial susceptibility pattern of Vibrio cholerae in our study we recommend to use any antibiotics among tetracycline, doxycycline, levofloxacin, azithromycin, chloramphenicol and ciprofloxacin for preliminary treatment of cholera in Nepal.

Highlights

Cholera is a major cause of mortality and morbidity in underdeveloped countries including Nepal
The cholera agent was identified as Vibrio cholerae serogroup O1 biotype El Tor and serotype Ogawa
Antibiotic susceptibility patterns of Vibrio cholerae toward different commonly used antibiotics All 31 isolates were resistant to ampicillin and cotrimoxazole

Summary

Introduction

Cholera is a major cause of mortality and morbidity in underdeveloped countries including Nepal. Drug resistance in Vibrio cholerae has become a serious problem mainly in developing countries. Vibrio cholerae is one of the most notorious enteric pathogens responsible for many cholera outbreaks [1]. Once commonly detected throughout the world, the infection is mainly confined to the under-developed countries, where the conditions of drinking water, sanitation and hygiene are not well maintained. It is endemic in Africa, South Asia, and Latin America. Cholera outbreaks usually occur when the drinking water and public sanitation systems are disrupted by natural disasters like earthquakes, tsunamis, volcanic eruptions, landslides and floods or due to crowding like in war displaced refugee camps [2]. Lack of prompt, proper treatment leads to shock within 6–12 h followed by death occurring between 18 h and several days [3]

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